2026 BlueCross Rx Value (PDP) formulary (drug list)
Contract S5953, plan 001 · South Carolina · 3,082 drugs on file · formulary ID 00026220. Each drug links to its cost in every CMS PDP Region 09 plan.
205 drugs starting with T.
| Drug name | Tier | 30-day preferred pharmacy | 90-day mail order | Usage management |
|---|---|---|---|---|
| TABLOID 40 mg TabletThioguanine | 4Non-Preferred Drug | 50% | 50% | None |
| TABRECTA 150 mg Tablet, Film CoatedCapmatinib | 5Specialty Tier | 25% | N/A |
|
| TABRECTA 200 mg Tablet, Film CoatedCapmatinib | 5Specialty Tier | 25% | N/A |
|
| TACROLIMUS .3 mg/g Ointment | 4Non-Preferred Drug | 50% | 50% | None |
| TACROLIMUS .5 mg Capsule | 4Non-Preferred Drug | 50% | 50% |
|
| TACROLIMUS 1 mg Capsule | 4Non-Preferred Drug | 50% | 50% |
|
| TACROLIMUS 1 mg/g Ointment | 4Non-Preferred Drug | 50% | 50% | None |
| TACROLIMUS 5 mg Capsule | 4Non-Preferred Drug | 50% | 50% |
|
| TADALAFIL 2.5 mg Tablet, Film Coated | 4Non-Preferred Drug | 50% | 50% |
|
| TADALAFIL 20 mg Tablet, Film Coated | 4Non-Preferred Drug | 50% | 50% |
|
| TADALAFIL 5 mg Tablet | 4Non-Preferred Drug | 50% | 50% |
|
| TAFINLAR 10 mg Tablet, For SuspensionDabrafenib | 5Specialty Tier | 25% | N/A |
|
| TAFINLAR 50 mg CapsuleDabrafenib | 5Specialty Tier | 25% | N/A |
|
| TAFINLAR 75 mg CapsuleDabrafenib | 5Specialty Tier | 25% | N/A |
|
| TAGRISSO 40 mg Tablet, Film CoatedOsimertinib | 5Specialty Tier | 25% | N/A |
|
| TAGRISSO 80 mg Tablet, Film CoatedOsimertinib | 5Specialty Tier | 25% | N/A |
|
| TALZENNA .1 mg Capsule, Liquid FilledTalazoparib | 5Specialty Tier | 25% | N/A |
|
| TALZENNA .25 mg Capsule, Liquid FilledTalazoparib | 5Specialty Tier | 25% | N/A |
|
| TALZENNA .35 mg Capsule, Liquid FilledTalazoparib | 5Specialty Tier | 25% | N/A |
|
| TALZENNA .5 mg Capsule, Liquid FilledTalazoparib | 5Specialty Tier | 25% | N/A |
|
| TALZENNA .75 mg Capsule, Liquid FilledTalazoparib | 5Specialty Tier | 25% | N/A |
|
| TALZENNA 1 mg Capsule, Liquid FilledTalazoparib | 5Specialty Tier | 25% | N/A |
|
| TAMOXIFEN CITRATE 10 mg Tablet, Film Coated | 2Generic | $17.00 | $42.50 | None |
| TAMOXIFEN CITRATE 20 mg Tablet, Film Coated | 2Generic | $17.00 | $42.50 | None |
| TAMSULOSIN HYDROCHLORIDE .4 mg Capsule | 2Generic | $17.00 | $42.50 | None |
| TARINA FE 1/20 EQ KitNorethindrone Acetate And Ethinyl Estradiol And Ferrous Fumarate | 3Preferred Brand | 17% | 17% | None |
| TAZAROTENE 1 mg/g Cream | 4Non-Preferred Drug | 50% | 50% |
|
| TAZICEF 1 g Injection, Powder, For SolutionCeftazidime | 3Preferred Brand | 17% | 17% | None |
| TAZICEF 2 g Injection, Powder, For SolutionCeftazidime | 3Preferred Brand | 17% | 17% | None |
| TAZICEF 6 g Injection, Powder, For SolutionCeftazidime | 3Preferred Brand | 17% | 17% | None |
| TAZVERIK 200 mg Tablet, Film CoatedTazemetostat | 5Specialty Tier | 25% | N/A |
|
| TEFLARO 400 mg/20mL Powder, For SolutionCeftaroline Fosamil | 5Specialty Tier | 25% | N/A | None |
| TEFLARO 600 mg/20mL Powder, For SolutionCeftaroline Fosamil | 5Specialty Tier | 25% | N/A | None |
| TELMISARTAN 20 mg Tablet | 6Select Care Drugs | $5.00 | $12.50 | None |
| TELMISARTAN 40 mg Tablet | 6Select Care Drugs | $5.00 | $12.50 | None |
| TELMISARTAN 80 mg Tablet | 6Select Care Drugs | $5.00 | $12.50 | None |
| TEMAZEPAM 15 mg Capsule | 3Preferred Brand | 17% | 17% |
|
| TEMAZEPAM 30 mg Capsule | 3Preferred Brand | 17% | 17% |
|
| TENOFOVIR DISOPROXIL FUMARATE 300 mg Tablet, Film Coated | 4Non-Preferred Drug | 50% | 50% |
|
| TEPMETKO 225 mg TabletTepotinib Hydrochloride | 5Specialty Tier | 25% | N/A |
|
| TERAZOSIN 1 mg CapsuleTerazosin Hydrochloride | 2Generic | $17.00 | $42.50 | None |
| TERAZOSIN 10 mg CapsuleTerazosin Hydrochloride | 2Generic | $17.00 | $42.50 | None |
| TERAZOSIN 2 mg CapsuleTerazosin Hydrochloride | 2Generic | $17.00 | $42.50 | None |
| TERAZOSIN 5 mg CapsuleTerazosin Hydrochloride | 2Generic | $17.00 | $42.50 | None |
| TERBINAFINE 250 mg TabletTerbinafine Hydrochloride | 2Generic | $17.00 | $42.50 |
|
| TERCONAZOLE 4 mg/g Cream | 3Preferred Brand | 17% | 17% | None |
| TERCONAZOLE 8 mg/g Cream | 3Preferred Brand | 17% | 17% | None |
| TERIPARATIDE 250 ug/mL Injection | 5Specialty Tier | 25% | N/A |
|
| TESTOSTERONE 10 mg/g Gel | 4Non-Preferred Drug | 50% | 50% |
|
| TESTOSTERONE 10 mg/g Gel | 4Non-Preferred Drug | 50% | 50% |
|
| TESTOSTERONE 16.2 mg/g Gel | 4Non-Preferred Drug | 50% | 50% |
|
| TESTOSTERONE CYPIONATE 100 mg/mL Injection, Solution | 2Generic | $17.00 | $42.50 |
|
| TESTOSTERONE CYPIONATE 200 mg/mL Injection | 2Generic | $17.00 | $42.50 |
|
| TESTOSTERONE CYPIONATE 200 mg/mL Injection, Solution | 2Generic | $17.00 | $42.50 |
|
| TESTOSTERONE ENANTHATE 200 mg/mL Injection, Solution | 3Preferred Brand | 17% | 17% |
|
| TESTOSTERONE GEL, 1% 10 mg/g Gel | 4Non-Preferred Drug | 50% | 50% |
|
| TETRABENAZINE 12.5 mg Tablet | 4Non-Preferred Drug | 50% | 50% |
|
| TETRABENAZINE 25 mg Tablet | 5Specialty Tier | 25% | N/A |
|
| TETRACYCLINE HYDROCHLORIDE 250 mg Capsule | 3Preferred Brand | 17% | 17% | None |
| TETRACYCLINE HYDROCHLORIDE 500 mg Capsule | 3Preferred Brand | 17% | 17% | None |
| THEOPHYLLINE 300 mg Tablet, Extended Release | 4Non-Preferred Drug | 50% | 50% | None |
| THEOPHYLLINE 400 mg Tablet, Extended Release | 3Preferred Brand | 17% | 17% | None |
| THEOPHYLLINE 450 mg Tablet, Extended Release | 4Non-Preferred Drug | 50% | 50% | None |
| THEOPHYLLINE 600 mg Tablet, Extended Release | 3Preferred Brand | 17% | 17% | None |
| THIORIDAZINE HYDROCHLORIDE 10 mg Tablet, Film Coated | 3Preferred Brand | 17% | 17% | None |
| THIORIDAZINE HYDROCHLORIDE 100 mg Tablet, Film Coated | 3Preferred Brand | 17% | 17% | None |
| THIORIDAZINE HYDROCHLORIDE 25 mg Tablet, Film Coated | 3Preferred Brand | 17% | 17% | None |
| THIORIDAZINE HYDROCHLORIDE 50 mg Tablet, Film Coated | 3Preferred Brand | 17% | 17% | None |
| THIOTHIXENE 1 mg Capsule | 4Non-Preferred Drug | 50% | 50% | None |
| THIOTHIXENE 10 mg Capsule | 4Non-Preferred Drug | 50% | 50% | None |
| THIOTHIXENE 2 mg Capsule | 4Non-Preferred Drug | 50% | 50% | None |
| THIOTHIXENE 5 mg Capsule | 4Non-Preferred Drug | 50% | 50% | None |
| TIADYLT ER 120 mg Capsule, Extended ReleaseDiltiazem Hydrochloride | 2Generic | $17.00 | $42.50 | None |
| TIADYLT ER 180 mg Capsule, Extended ReleaseDiltiazem Hydrochloride | 2Generic | $17.00 | $42.50 | None |
| TIADYLT ER 240 mg Capsule, Extended ReleaseDiltiazem Hydrochloride | 2Generic | $17.00 | $42.50 | None |
| TIADYLT ER 300 mg Capsule, Extended ReleaseDiltiazem Hydrochloride | 2Generic | $17.00 | $42.50 | None |
| TIADYLT ER 360 mg Capsule, Extended ReleaseDiltiazem Hydrochloride | 2Generic | $17.00 | $42.50 | None |
| TIADYLT ER 420 mg Capsule, Extended ReleaseDiltiazem Hydrochloride | 2Generic | $17.00 | $42.50 | None |
| TIAGABINE HYDROCHLORIDE 12 mg Tablet, Film Coated | 4Non-Preferred Drug | 50% | 50% | None |
| TIAGABINE HYDROCHLORIDE 16 mg Tablet, Film Coated | 4Non-Preferred Drug | 50% | 50% | None |
| TIAGABINE HYDROCHLORIDE 2 mg Tablet | 4Non-Preferred Drug | 50% | 50% | None |
| TIAGABINE HYDROCHLORIDE 4 mg Tablet | 4Non-Preferred Drug | 50% | 50% | None |
| TIBSOVO 250 mg Tablet, Film CoatedIvosidenib | 5Specialty Tier | 25% | N/A |
|
| TICAGRELOR 60 mg Tablet, Film Coated | 4Non-Preferred Drug | 50% | 50% | None |
| TICAGRELOR 90 mg Tablet | 4Non-Preferred Drug | 50% | 50% | None |
| TICOVAC 1.2 ug/.25mL InjectionTick-Borne Encephalitis Vaccine | 3Preferred Brand | 17% | 17% | None |
| TICOVAC 2.4 ug/.5mL InjectionTick-Borne Encephalitis Vaccine | 1Preferred Generic | $12.00 | $30.00 | None |
| TIGECYCLINE 50 mg Injection, Powder, Lyophilized, For Solution | 4Non-Preferred Drug | 50% | 50% | None |
| TIMOLOL MALEATE 10 mg Tablet | 3Preferred Brand | 17% | 17% | None |
| TIMOLOL MALEATE 2.5 mg/mL Solution/ Drops | 2Generic | $17.00 | $42.50 | None |
| TIMOLOL MALEATE 5 mg/mL Solution/ Drops | 2Generic | $17.00 | $42.50 | None |
| TINDAZOLE 250 mg Tablet, Film CoatedTinidazole | 3Preferred Brand | 17% | 17% | None |
| TINIDAZOLE 500 mg Tablet | 3Preferred Brand | 17% | 17% | None |
| TIOTROPIUM BROMIDE 18 ug Capsule | 4Non-Preferred Drug | 50% | 50% |
|
| TIVICAY 50 mg Tablet, Film CoatedDolutegravir Sodium | 5Specialty Tier | 25% | N/A |
|
| TIVICAY PD 5 mg Tablet, For SuspensionDolutegravir Sodium | 4Non-Preferred Drug | 50% | 50% |
|
| TIZANIDINE 2 mg Tablet | 2Generic | $17.00 | $42.50 | None |
| TIZANIDINE 4 mg Tablet | 2Generic | $17.00 | $42.50 | None |
| TOBRADEX ST 3/.5 mg/mL Suspension/ DropsTobramycin / Dexamethasone | 4Non-Preferred Drug | 50% | 50% | None |
| TOBRAMYCIN 10 mg/mL Injection, SolutionTobramycin Sulfate | 4Non-Preferred Drug | 50% | 50% | None |
| TOBRAMYCIN 3 mg/mL Solution/ Drops | 2Generic | $17.00 | $42.50 | None |
| TOBRAMYCIN 300 mg/5mL Solution | 3Preferred Brand | 17% | 17% |
|
| TOBRAMYCIN 40 mg/mL Injection, SolutionTobramycin Sulfate | 4Non-Preferred Drug | 50% | 50% | None |
| TOBRAMYCIN AND DEXAMETHASONE 3/1 mg/mL Suspension/ Drops | 4Non-Preferred Drug | 50% | 50% | None |
| TOLVAPTAN 15 mg Tablet | 5Specialty Tier | 25% | N/A |
|
| TOLVAPTAN 30 mg Tablet | 5Specialty Tier | 25% | N/A |
|
| TOPIRAMATE 100 mg Tablet, Film Coated | 2Generic | $17.00 | $42.50 | None |
| TOPIRAMATE 15 mg Capsule, Coated Pellets | 3Preferred Brand | 17% | 17% | None |
| TOPIRAMATE 200 mg Tablet | 2Generic | $17.00 | $42.50 | None |
| TOPIRAMATE 25 mg Capsule, Coated Pellets | 3Preferred Brand | 17% | 17% | None |
| TOPIRAMATE 25 mg Tablet, Film Coated | 2Generic | $17.00 | $42.50 | None |
| TOPIRAMATE 25 mg/mL Solution | 4Non-Preferred Drug | 50% | 50% | None |
| TOPIRAMATE 50 mg Capsule, Coated Pellets | 3Preferred Brand | 17% | 17% | None |
| TOPIRAMATE 50 mg Tablet, Film Coated | 2Generic | $17.00 | $42.50 | None |
| TOREMIFENE CITRATE 60 mg Tablet | 4Non-Preferred Drug | 50% | 50% | None |
| TORPENZ 10 mg TabletEverolimus | 5Specialty Tier | 25% | N/A |
|
| TORPENZ 2.5 mg TabletEverolimus | 5Specialty Tier | 25% | N/A |
|
| TORPENZ 5 mg TabletEverolimus | 5Specialty Tier | 25% | N/A |
|
| TORPENZ 7.5 mg TabletEverolimus | 5Specialty Tier | 25% | N/A |
|
| TORSEMIDE 10 mg Tablet | 2Generic | $17.00 | $42.50 | None |
| TORSEMIDE 100 mg Tablet | 2Generic | $17.00 | $42.50 | None |
| TORSEMIDE 20 mg Tablet | 2Generic | $17.00 | $42.50 | None |
| TORSEMIDE 5 mg Tablet | 2Generic | $17.00 | $42.50 | None |
| TOUJEO 300 U/mL Injection, SolutionInsulin Glargine | 3Preferred Brand | 17% | 17% | None |
| TOUJEO MAX 300 U/mL Injection, SolutionInsulin Glargine | 3Preferred Brand | 17% | 17% | None |
| TRADJENTA 5 mg Tablet, Film CoatedLinagliptin | 3Preferred Brand | 17% | 17% |
|
| TRAMADOL HYDROCHLORIDE 50 mg Tablet, Coated | 2Generic | $17.00 | $42.50 | None |
| TRAMADOL HYDROCHLORIDE AND ACETAMINOPHEN 37.5/325 mg Tablet | 2Generic | $17.00 | $42.50 | None |
| TRANDOLAPRIL 1 mg Tablet | 6Select Care Drugs | $5.00 | $12.50 | None |
| TRANDOLAPRIL 2 mg Tablet | 6Select Care Drugs | $5.00 | $12.50 | None |
| TRANDOLAPRIL 4 mg Tablet | 6Select Care Drugs | $5.00 | $12.50 | None |
| TRANEXAMIC ACID 650 mg Tablet | 3Preferred Brand | 17% | 17% | None |
| TRANYLCYPROMINE 10 mg Tablet | 4Non-Preferred Drug | 50% | 50% | None |
| TRAZODONE HYDROCHLORIDE 100 mg Tablet | 2Generic | $17.00 | $42.50 | None |
| TRAZODONE HYDROCHLORIDE 150 mg Tablet | 2Generic | $17.00 | $42.50 | None |
| TRAZODONE HYDROCHLORIDE 50 mg Tablet | 2Generic | $17.00 | $42.50 | None |
| TRELEGY ELLIPTA 100/62.5/25 ug PowderFluticasone Furoate, Umeclidinium Bromide And Vilanterol Trifenatate | 3Preferred Brand | 17% | 17% |
|
| TRELEGY ELLIPTA 200/62.5/25 ug PowderFluticasone Furoate, Umeclidinium Bromide And Vilanterol Trifenatate | 3Preferred Brand | 17% | 17% |
|
| TRELSTAR KitTriptorelin Pamoate | 4Non-Preferred Drug | 50% | 50% |
|
| TRELSTAR KitTriptorelin Pamoate | 4Non-Preferred Drug | 50% | 50% |
|
| TRESIBA 100 U/mL Injection, SolutionInsulin Degludec | 3Preferred Brand | 17% | 17% | None |
| TRESIBA 100 U/mL Injection, SolutionInsulin Degludec | 3Preferred Brand | 17% | 17% | None |
| TRESIBA 200 U/mL Injection, SolutionInsulin Degludec | 3Preferred Brand | 17% | 17% | None |
| TRETINOIN .25 mg/g Cream | 3Preferred Brand | 17% | 17% |
|
| TRETINOIN .5 mg/g Cream | 4Non-Preferred Drug | 50% | 50% |
|
| TRETINOIN 10 mg Capsule | 5Specialty Tier | 25% | N/A | None |
| TRI-ESTARYLLA KitNorgestimate And Ethinyl Estradiol | 3Preferred Brand | 17% | 17% | None |
| TRI-MILI KitNorgestimate And Ethinyl Estradiol | 3Preferred Brand | 17% | 17% | None |
| TRI-SPRINTEC KitNorgestimate And Ethinyl Estradiol | 3Preferred Brand | 17% | 17% | None |
| TRI-VYLIBRA KitNorgestimate And Ethinyl Estradiol | 3Preferred Brand | 17% | 17% | None |
| TRIAMCINOLONE ACETONIDE .25 mg/g Cream | 2Generic | $17.00 | $42.50 | None |
| TRIAMCINOLONE ACETONIDE .25 mg/g Ointment | 2Generic | $17.00 | $42.50 | None |
| TRIAMCINOLONE ACETONIDE .25 mg/mL Lotion | 3Preferred Brand | 17% | 17% | None |
| TRIAMCINOLONE ACETONIDE 1 mg/g Cream | 2Generic | $17.00 | $42.50 | None |
| TRIAMCINOLONE ACETONIDE 1 mg/g Ointment | 2Generic | $17.00 | $42.50 | None |
| TRIAMCINOLONE ACETONIDE 1 mg/g Paste | 3Preferred Brand | 17% | 17% | None |
| TRIAMCINOLONE ACETONIDE 1 mg/mL Lotion | 2Generic | $17.00 | $42.50 | None |
| TRIAMCINOLONE ACETONIDE 5 mg/g Cream | 2Generic | $17.00 | $42.50 | None |
| TRIAMCINOLONE ACETONIDE 5 mg/g Ointment | 2Generic | $17.00 | $42.50 | None |
| TRIAMTERENE 100 mg Capsule | 4Non-Preferred Drug | 50% | 50% | None |
| TRIAMTERENE 50 mg Capsule | 4Non-Preferred Drug | 50% | 50% | None |
| TRIAMTERENE AND HYDROCHLOROTHIAZIDE 37.5/25 mg Tablet | 1Preferred Generic | $12.00 | $30.00 | None |
| TRIAMTERENE AND HYDROCHLOROTHIAZIDE 75/50 mg Tablet | 1Preferred Generic | $12.00 | $30.00 | None |
| TRIDERM 5 mg/g CreamTriamcinolone Acetonide | 2Generic | $17.00 | $42.50 | None |
| TRIENTINE HYDROCHLORIDE 250 mg Capsule | 5Specialty Tier | 25% | N/A |
|
| TRIFLUOPERAZINE HYDROCHLORIDE 1 mg Tablet, Film Coated | 3Preferred Brand | 17% | 17% | None |
| TRIFLUOPERAZINE HYDROCHLORIDE 10 mg Tablet, Film Coated | 3Preferred Brand | 17% | 17% | None |
| TRIFLUOPERAZINE HYDROCHLORIDE 2 mg Tablet, Film Coated | 3Preferred Brand | 17% | 17% | None |
| TRIFLUOPERAZINE HYDROCHLORIDE 5 mg Tablet, Film Coated | 3Preferred Brand | 17% | 17% | None |
| TRIFLURIDINE 10 mg/mL Solution | 4Non-Preferred Drug | 50% | 50% | None |
| TRIHEXYPHENIDYL HYDROCHLORIDE 2 mg Tablet | 3Preferred Brand | 17% | 17% | None |
| TRIHEXYPHENIDYL HYDROCHLORIDE 5 mg Tablet | 3Preferred Brand | 17% | 17% | None |
| TRIJARDY XR 10/5/1000 mg Tablet, Extended ReleaseEmpagliflozin, Linagliptin, Metformin Hydrochloride | 3Preferred Brand | 17% | 17% | None |
| TRIJARDY XR 12.5/2.5/1000 mg Tablet, Extended ReleaseEmpagliflozin, Linagliptin, Metformin Hydrochloride | 3Preferred Brand | 17% | 17% | None |
| TRIJARDY XR 25/5/1000 mg Tablet, Extended ReleaseEmpagliflozin, Linagliptin, Metformin Hydrochloride | 3Preferred Brand | 17% | 17% | None |
| TRIJARDY XR 5/2.5/1000 mg Tablet, Extended ReleaseEmpagliflozin, Linagliptin, Metformin Hydrochloride | 3Preferred Brand | 17% | 17% | None |
| TRIKAFTA KitElexacaftor, Tezacaftor, And Ivacaftor | 5Specialty Tier | 25% | N/A |
|
| TRIMETHOPRIM 100 mg Tablet | 2Generic | $17.00 | $42.50 | None |
| TRIMIPRAMINE 100 mg Capsule | 4Non-Preferred Drug | 50% | 50% | None |
| TRIMIPRAMINE 25 mg Capsule | 4Non-Preferred Drug | 50% | 50% | None |
| TRIMIPRAMINE 50 mg Capsule | 4Non-Preferred Drug | 50% | 50% | None |
| TRINTELLIX 10 mg Tablet, Film CoatedVortioxetine | 4Non-Preferred Drug | 50% | 50% |
|
| TRINTELLIX 20 mg Tablet, Film CoatedVortioxetine | 4Non-Preferred Drug | 50% | 50% |
|
| TRINTELLIX 5 mg Tablet, Film CoatedVortioxetine | 4Non-Preferred Drug | 50% | 50% |
|
| TRIUMEQ 600/50/300 mg Tablet, Film CoatedAbacavir Sulfate, Dolutegravir Sodium, Lamivudine | 5Specialty Tier | 25% | N/A |
|
| TRIUMEQ PD KitAbacavir Sulfate, Dolutegravir Sodium, Lamivudine | 4Non-Preferred Drug | 50% | 50% |
|
| TRULICITY .75 mg/.5mL Injection, SolutionDulaglutide | 3Preferred Brand | 17% | 17% |
|
| TRULICITY 1.5 mg/.5mL Injection, SolutionDulaglutide | 3Preferred Brand | 17% | 17% |
|
| TRULICITY 3 mg/.5mL Injection, SolutionDulaglutide | 3Preferred Brand | 17% | 17% |
|
| TRULICITY 4.5 mg/.5mL Injection, SolutionDulaglutide | 3Preferred Brand | 17% | 17% |
|
| TRUMENBA 60/60 ug/.5mL Injection, SuspensionMeningococcal Group B Vaccine | 1Preferred Generic | $12.00 | $30.00 | None |
| TRUQAP 200 mg Tablet, Film CoatedCapivasertib | 5Specialty Tier | 25% | N/A |
|
| TRYNGOLZA 80 mg/.8mL Injection, SolutionOlezarsen Sodium | 5Specialty Tier | 25% | N/A |
|
| TUKYSA 150 mg TabletTucatinib | 5Specialty Tier | 25% | N/A |
|
| TUKYSA 50 mg TabletTucatinib | 5Specialty Tier | 25% | N/A |
|
| TURALIO 125 mg CapsulePexidartinib Hydrochloride | 5Specialty Tier | 25% | N/A |
|
| TURQOZ KitNorgestrel And Ethinyl Estradiol | 3Preferred Brand | 17% | 17% | None |
| TWINRIX 720/20 [iU]/mL/ug/mL Injection, SuspensionHepatitis A And Hepatitis B (Recombinant) Vaccine | 1Preferred Generic | $12.00 | $30.00 | None |
| TYBOST 150 mg Tablet, Film CoatedCobicistat | 3Preferred Brand | 17% | 17% |
|
| TYENNE 162 mg/.9mL Injection, SolutionTocilizumab-Aazg | 5Specialty Tier | 25% | N/A |
|
| TYENNE 162 mg/.9mL Injection, SolutionTocilizumab-Aazg | 5Specialty Tier | 25% | N/A |
|
| TYMLOS 3.12 mg/1.56mL Injection, SolutionAbaloparatide | 5Specialty Tier | 25% | N/A |
|
| TYPHIM VI 25 ug/.5mL Injection, SolutionSalmonella Typhi Ty2 Vi Polysaccharide Antigen | 1Preferred Generic | $12.00 | $30.00 | None |
| TYPHIM VI 25 ug/.5mL Injection, SolutionSalmonella Typhi Ty2 Vi Polysaccharide Antigen | 1Preferred Generic | $12.00 | $30.00 | None |
| TYRVAYA .03 mg/.05mL SprayVarenicline | 4Non-Preferred Drug | 50% | 50% |
|
PA = prior authorization, ST = step therapy, QL = quantity limit. Costs are the plan’s initial-coverage cost-sharing from the CMS 2026 formulary files; a drug not listed here is not on this plan’s formulary, though a formulary exception may still be possible.